<h1 class="underline"><?php echo __('IP_contact_title') ?></h1>
<?php echo $this->load->view('powercms/message'); ?>
<div class="clear"></div>
<form action="<?php echo $submit_uri; ?>" method="post" class="label-top">
    <div>
        <h4><?php echo __("IP_fullname"); ?> : </h4>
        <input type="text" value="" name="name"> <span>*</span>
    </div>
    <div>
        <h4><?php echo __("IP_email"); ?> : </h4>
        <input type="text" value="" name="email"> <span>*</span>
    </div>
    <div>
        <h4><?php echo __("IP_phone"); ?> : </h4>
        <input type="text" value="" name="phone"> <span>*</span>
    </div>
    <div>
        <h4><?php echo __("IP_content"); ?> : </h4>
        <textarea rows="8" cols="40" name="content"></textarea> 
    </div>
    <div>
        <h4><?php echo __("IP_capcha"); ?> : </h4>
        <input type="text" name="security_code"> <span>*</span>
        <br><img src="/security_code">
    </div>
    <div>
        <input type="submit" value="<?php echo __('IP_send_contact'); ?>" class="input_button blue_gradient">
    </div>
</form>
